What are the responsibilities and job description for the Claims Examiner position at A.P.R., Inc. (AlphaProTemps)?
The claims examiner reports directly to the claims manager. They are primarily responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims that are received from PHP affiliated medical groups and hospitals for HMO patients.Must have listed claims reimbursement experienceMust have DOFRMust have processed lab claimsEDUCATION/EXPERIENCE/TRAINING:High school graduate or equivalent required. Must have physical proof on hand if background check is unable to verify your education background.Minimum of 2 years claims ADJUDICATION related experience in ambulatory, acute care hospital, HMO, or IPA environmentKnowledge of payment methodologies for: Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary ServicesKnowledge and understanding of timeliness and payment accuracy guidelines for commercial, senior and Medi-Cal claimsKnowledge of compliance issues as they relate to claims processingExperience in interpreting provider contract reimbursement terms desirableAbility to identify non-contracted providers for Letter of Agreement considerationData entry experienceTraining on basic office automation and managed care computer systems.Company DescriptionAlphaProTemps is specialized in providing "best-in-class" professional staff augmentation services. These recruiting directives include temporary labor, contract sourcing, professional & technical niches, vendor-on-site, and managed service programs.
Salary : $27